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16—27179-1 GPO 






SPECIAL REGULATIONS NO. 65c 



PHYSICAL EXAMINATION 
FOR FLYING 



Prepared in the office of the 
Director of Air Service 



1919 


# 


w 


WASHINGTON 


GOVERNMENT PRINTING OFFiCE 


1919 



SPECIAL REGULATIONS NO. 65c. 



WAR DEPARTMENT, 

Washington, October 23, 1919. 
The following instructions relative to physical examinations for 
flying are published for the information and guidance of all con- 
cerned. 

All previous instructions which conflict with the provisions of these 
regulations are rescinded. 
[210.12, A. G. O.] 

By order of the Secretary of War: 

PEYTON C. MARCH, 
General, Chief of Staff. 
Official : 

P. C. HARRIS, 

The Adjutant General. 

(2) : 1-i 

8S o£ -'* 
B ..2* 1923. 



I- 



TABLE OF CONTENTS, 



Paragraphs. 
Section I. General instructions and disposition of records of 

examinations 1-10 

Section II. Examinations 11—42 

148G84— 19 (3) 



PHYSICAL EXAMINATION FOR FLYING. 



Section I. 



GENERAL INSTRUCTIONS AND DISPOSITION OF RECORDS 
OF EXAMINATIONS. 

1. Physical examinations for flying will be made only by such medi- 
cal officers as are authorized in writing by the Surgeon General or" 
the Army to conduct such examinations and will be conducted as pre- 
scribed in these regulations. Officers making physical examinations 
will under no circumstances waive physical defects. 

2. All applicants for heavier or lighter-than-air flying training will 
be subjected to a rigid physical examination and will not be allowed to 
proceed with their flying training until an approved copy of Form No. 
609, A. G. O., in each case has been received back at the station of 
the applicant. 

3. A record of the examination, in triplicate, will be made on Form 
No. 609, A. G. O. Two copies will be forwarded directly to the office 
of the Director of Air Service, attention Chief Surgeon, Air Service, 
and the third copy retained by the flight surgeon at the station of the 
candidate. Upon receipt of the two copies of Form No. 609, A. G. O., 
they will be approved or disapproved by the Chief Surgeon, Air Serv- 
ice, one copy retained for permanent file, and one copy returned to 
the station from which received. 

4. Upon receipt back at the station of the copy of Form No. 609, 
A. G. O., the action of the Chief Surgeon, Air Service, contained 
thereon will be transcribed to the retained copy of the form and the 
same certified as a " true copy." 

5. Whenever an individual is transferred to another station, the 
copy of Form No. 609, A. G. O., with the action certified thereon, as 
provided in paragraph 3 above, will be forwarded to the flight sur- 
geon of the new station. The other copy of Form No. 609, A. G. O., 
will be retained at the station for permanent file. 

6. No rating for flying status will be given until the report of the 
board of officers received in the office of the Director of Air Service 
has been furnished the Chief Surgeon, and same has been received 
back from the Chief Surgeon with a statement to the effect that the 
candidate is considered physically qualified for the rating recom- 
mended. A copy of the statement will be filed with the report of the 
board of officers on the candidate under consideration. 

7. Reexaminations will be required from time to time, as deemed 
expedient by the Director of Air Service, or as considered necessary 
by commanding officers, to determine the physical fitness of anyone 
to continue on flying training or duty. Commanding officers are au- 
thorized, upon recommendation of the flight surgeon, to suspend the 
ilying training of, or to relieve from flying duty, any individual con- 

(5) 



sldered physically incapacitated, and to authorize the resumption of 
such training when the individual is found physically fit. Whenever 
such incapacity is not the result of a disability incurred as a result 
of participation in aerial flights, the individual will be relieved from 
flying status until the disability is removed. 

8. Commanding officers of Air Service stations will require the 
flight surgeon, or the post surgeon in the absence of the former, to 
investigate the physical examination records of all commissioned 
and enlisted personnel engaged in flying or under flying instruction in 
January and July of each year. 

9. A report of this investigation covering the flying personnel, for 
all personnel for whom reports have not been submitted, giving name, 
rank, and organization and whether qualified or disqualified for fly- 
ing, as shown by the record on Form No. 609, A. G. O., will be for- 
warded through the commanding officer to the Director of Air Serv- 
ice, attention Chief Surgeon, Air Service. If the record on Form No. 
609, A. G. O., is not found, or is incomplete in any case, these facts 
will also be reported. 

10. In cases where the physical examination record is incomplete, 
unsatisfactory, or missing, the commanding officer will immediately 
direct discontinuance in flying until the physical qualifications have 
been properly determined, recorded and certified, as required in these 
regulations. 



Section II. 
EXAMINATION. 

EYE. 

11. Visual acuity. — a. Apparatus and set-up: Five Snellen test 
charts, each with a different arrangement of letters; a blank card 
about 6 by 9 cm. Four of the test charts are partially covered by 
black paper, leaving exposed only the 20 feet and successive smaller 
rows of letters. One chart is left fully exposed. The five charts are 
arranged in close formation against a neutral colored wall at the end 
of the examination room and each one numbered. These numerals 
must be distinctly visible at a distance of 20 feet. Two 100-watt 
daylight Mazda lamps with reflectors are installed about four feet 
above and in front of the test charts to provide uniform illumination. 
A single 200-watt daylight Mazda lamp in a suitable reflector may be 
substituted for the above. The switches controlling these lamps and 
the spot light used with the phorometer-trial frame should be located 
on the side wall where they can be reached easily by the examiner 
as he stands beside the applicant's chair. All windows and other 
sources of light located in front and to the side of the applicant are 
shaded during the examination. 

b. Procedure: Immediately upon entering the room, the applicant 
occupies a chair facing the test charts 20 feet away. The test is 
begun promptly to prevent study of the letters. The examiner stands 
at one side of the applicant, using the 6 by 9 cm. card to cover the 
left eye while the right is being tested. Designating one of the partly 
exposed charts by number, the examiner instructs the applicant to 
read as many letters as possible. When the best vision for the right 
eye has been obtained, the card is shifted to cover the right eye and 
the left eye is tested on one of the other partially exposed charts. 
The fully exposed chart is used only when vision is less than 20/20. 
The row of smallest letters read correctly, determines the fraction 
used in recording visual acuity. The number of smaller letters read 
in the next line is added to this fraction following the plus sign, e. g., 
20/20+5. 

- c. Precautions: Every possible safeguard is thrown around the 
test to prevent memorizing the charts. Applicants awaiting their 
visual acuity test are not permitted to remain in the room within 
sight of the test letters nor where they can "hear them read aloud. 

Each eye is completely screened from the letters while the other is 
being tested. The use of the hand or of an opaque disk from the trial 
case as a screen does not insure a monocular test. 

d, Interpretation of findings: The minimal visional requirement 
for each eye is 20/20. If two or three letters are not read in the 
20/20 line they may be off-set by an equal number of letters read in 
the 20/15 line. 

(7) 



8 

12. Depth perception at 6 meters. — a. Apparatus: Directions for 
the construction of this simple apparatus accompany the ophthalino- 
iogieal equipment. It is placed permanently against the wall be- 
neath the Snellen test charts where it will receive the overhead 
illumination. 

b. Procedure : The rods in the box are widely separated by the ex- 
aminer and the applicant instructed to manipulate the two cords so 
as to bring the movable rod beside the fixed one in a position where 
both rods appear to be the same distance from him. The test is re- 
peated several times, the rods being widely separated before each 
trial. The applicant's estimation of depth difference is read in milli- 
meters directly from the scale and entered on the record. 

c. Precautions : All information concerning the results of the suc- 
cessive trials is denied the applicant before the test is completed. 

<1. Interpretation of findings: An average depth difference of more 
than 30 mm. disqualifies the applicant. 

13. The Maddox rod screen test at 6 meters. — a. Apparatus : A 
phorometer-trial frame equipped with a pair of multiple Maddox rods 
and a pair of Kisloy rotary prisms; a blank card about 6 by 9 cm., 
which serves ns a screen; a spot light about one cm. in diameter. 

b. Procedure: Before beginning the test the applicant's sighting 
or fixing eye is determined. For this purpose, a blank card about 
13 by 20 cm. with a 3 cm. round hole in the center is employed. The 
applicant, seated, facing the spot light 6 meters away, grasps the card 
by the short sides with both hands. While looking intently at the 
light, he slowly, raises the card at arm's length and locates the light 
through the hole without closing either eye. Only one eye can see 
the light through the hole and the eye selected for this purpose is the 
one used habitually for sighting or fixing. 

Having determined the sighting eye, the phorometer-trial frame is 
adjusted closely in front of the applicant's eyes. One of the multiple 
Maddox rods is swung into position before the nonfixing eye. A ro- 
tary prism is placed before the same eye. The sighting or fixing eye 
must have a© unobstructed view of the spot light. For the measure- 
ment of esophoria or exophoria, the Maddox rod is adjusted to give a 
vertical line of light. The rotary prism is adjusted for the measure- 
ment of lateral (levin tion and set 4 or 5 prism diopters oil* the zero 
mark. This gives enough deilecfion at the first reading to detect an 
applicant who has been coached to say the line passes through the 
light. 

The 6 by 9 cm. card is moved from one eye to the other a few times 
to. ascertain if the applicant sees both The line and the light. If the 
line is not seen readiiy, the Maddox rod is readjusted by centering it 
carefully in front of the pupil. Some further darkening of the room 
may be necessary to reader it clearly visible. 

When the applicant sees both the line and the light easily, the ex- 
aminer holds the card or screen in front of the nonfixing eye to shut 
out the image of the line. The applicant now sees only the light. 
After he has fixed if for several seconds, the screen is removed for 
an instant and quickly replaced. In that brief interval the applicant 
should see the line and be able to locate it with reference to the light. 
After one or two such exposures he will say that the line is to the 



9 

right or left of the light or possibly tbrou§ll it. He is instructed to 
grasp the milled head that rotates the prism and turn it to bring the 
line directly into the light. To enahle him to do this, the screen is 
removed from the eye at intervals and quickly replaced. Finally the 
applicant will have rotated the prism enough to cause tiie line to pass 
through the light every time he sees it. when the screen is removed. 
The mimher of prism diopters necessary to do this is read from the 
scale of the rotary prism. This is entered on the record as esophoria 
if the prism is base out. and exophoria if the prism is base in. For 
the measurement of hyperphoria, the Maddox rod before the non- 
tixing eye is readjusted to give a horizontal line of light. The rotary 
prism is also readjusted to measure verticil deviation. The screen 
is ust d exactly as before to give an occasional glimpse of the line. 
The number of prism diopters read from the scale is recorded as right 
hyperphoria if the prism is base down before the right eye or base up 
before the left. It is recorded as left hyperphoria if the prism is base 
up before the right eye or base down before the left. 

c. Precautions: The phorometer attachment is not used for measur- 
ing the amount of heterophoria. The Maddox rod and the measur- 
ing prism are not used before the fixing eye. The test gives an 
inaccurate result if the applicant is permitted to see the line for a 
longer time than is allowed by the momentary exposure described 
above. 

(I. Interpretation of findings: Esophoria of more than 4A is a 
disqualifying factor if associated with less than 4A of prism diverg- 
ence, or if associated with diplopia in the lateral positions on the 
tangent curtain, or if associated with an amount of accommoda- 
tion near the lower limits, or if associated with an amount of 
hyperopia near the disqualifying limit. 

Exophoria of more than 2 A is a disqualifying factor if associ- 
ated with an angle of convergence near the disqualifying limit, or 
if associated with diplopia in the lateral positions on the tangent 
curtain. 

Hyperphoria of more than 3- A disqualifies the applicant without 
further supporting evidence. 

14. The Maddox rod screen test at 33 cm. — a. Apparatus: Pho- 
rometer-trial frame ; small light from electric ophthalmoscope. 

1). Procedure : The light is held in the median line 33 cm. from 
the eyes. The test proceeds exactly as described for 6 meters, but 
is not made for hyperphoria. 

c. Precautions: Same as for the 6-meter test. 

0. Interpretation of findings : Exophoria of 4A may be considered 
the normal condition. Any considerable variation from this condi- 
tion is to be interpreted* in connection with the other associated tests. 

15. Prism divergence.- — a. Apparatus: Phorometer-trial frame; 
spot light one cm. in diameter. 

/>. Procedure: The applicant is seated facing the spot light 20 feet 
away. The rotary prism of the phorometer-trial frame is adjusted 
before one eye so that by turning the nulled head, the prism will be 
acting base in. With the prism set at zero on the .scale, the appli- 
cant should see but one spot of light. As the prism is slowly rotated 
base in, diplopia will be produced. The number of prism diopters 



10 

which causes the onset of diplopia is read from the scale and entered 
on the record as prism divergence. 

c. Precautions : The test can not be made if the applicant has diplo- 
pia when the prism is set at zero on the scale. 

d. Interpretation of findings: Prism divergence of more than 9 A 
disqualifies the applicant if associated with an angle of convergence 
near the disqualifying limit. If less than 4 A of prism divergence is 
found associated with more than 4A of esophoria at 6 meters, the 
applicant is disqualified. 

16. Test of associated parallel movements. — a. Apparatus : A pin 
with a white head 2 mm. in diameter. 

&. Procedure : The applicant stands near a window where good 
illumination falls on both eyes. The examiner holds the white-headed 
pin about 33 cm. directly in front of the applicant's eyes and directs 
him to iGok at it steadily. Nystagmus in the primary position is to 
be noted at this stage of the test. The applicant is then instructed 
to hold his head still and watch the pin as it is moved slowly to his 
right. The pin is not carried beyond the field of binocular fixation, 
but is held motionless for a moment near the lateral limit of the 
field. Each eye is inspected to discover any failure in fixing the pin. 
The lagging or overaction of either eye is noted. The pin is then 
carried slowly to the extreme left, up and to the left, up and to the 
right, down and to the right, down and to the left. The lagging of 
either eye in any one of these six cardinal directions is due to under- 
action of at least one of the extrinsic ocular muscles. It may indi- 
cate a paresis or a complete paralysis. This underaction is recorded 
by stating which eye lags and in which direction the lagging is ob- 
served. In the same way any overshooting of either eye is recorded 
by stating which eye is involved and in which direction. 

If any underaction or overaction is revealed by this test, the final 
diagnosis is made or verified on the tangent curtain by means of a 
small electric light or candle and a red glass. From the associated 
parallel movement test and the plotting of diplopia on the tangent 
curtain, a diagnosis of the individual muscle or muscles involved is 
readily made. 

c. Interpretation of findings: The applicant is disqualified if the 
underaction or overaction of any of the extrinsic ocular muscles pro- 
duces diplopia except in the extreme positions, where a small separa- 
tion of the images may be disregarded. Nystagmus disqualifies if it 
is demonstrated except in extreme positions. 

17. Inspection of the eyes. — a. Procedure: Whenever possible 
the eyes are inspected by bright daylight. Every pathologic condi- 
tion and congenital anomaly is recorded. The following conditions 
are commonly found : 

Lids : Ptosis, blepharitis, trichiasis, entropion, ectropion, and chala- 
zion. 

Tear sac : Imperfect drainage. 

Lower punctum : Failure of contact with bulbar conjunctiva. 

Conjunctiva: Trachoma, and old scars. 

Cornea : Scars, pannus, and pterygium. 

Pupils: Unequal size, irregular shape, and failure to react to light 
or accommodation. 



11 



b. Interpretation of findings: Any pathologic condition which may 
become worse or interfere with the proper functioning of the eyes 
under the fatigue and exposure of flying, disqualifies the applicant. 

18. Accommodation. — a. Apparatus: The Prince rule; a small mil- 
limeter rule ; a card with several rows of small letters. 

b. Procedure: Accommodation is measured from the anterior focus 
of the eye which is about 11.5 mm. in front of the cornea. Using the 
millimeter rule, a pencil mark is made on each side of the applicant's 
nose 11.5 mm. in front of the right and the left cornea, respectively. 
In measuring the accommodation of the right eye, the flat side of the 
Prince rule is laid against the right side of the applicant's nose, with 
the end of the rule at the pencil mark. The rule is held horizon- 
tally and extends directly to the front. The card of test letters is 
held not more than 5 cm. in front of the applicant's right eye. His 
left is screened from sight of the letters by the flat side of the rule. 
The card of test letters is now carried slowly away from the eye and 
the applicant instructed to begin reading the letters aloud as soon as 
they become legible. The card is halted the instant he begins to 
read the letters correctly and the point on the rule opposite the card 
is read off in diopters. This is the measure of accommodation of the 
right eye. To test the left eye the rule is changed to the left side 
of the nose and the above procedure repeated, using a different line 
of letters. 

c. Precautions: The letters on the test card are read aloud. The 
same line of letters is not used for testing both eyes. The card is 
held close to the eye and carried away from it. 

d. Interpretation of findings: The appended table gives the mean 
values of accommodation in diopters from 18 to 50 years of age. 
Accommodation is normal if it lies between limits 2 diopters above 
and below the mean for the applicant's age. 

Table of mean values of accommodation power (Duane). 



Age. 


Diopters. 


Age. 


Diopters. 


Age. 


Diopters. 


Age. 


Diopters. 


18 


11.9 
11.7 
11.5 
11.2 
10.9 
10.6 
10.4 


j 25 


10.2 
9.9 
9.6 
9.4 
9.2 
8.9 


31 


i 

8.6 : 

8.3 i 

8.0 1 
7.7 
7.3 ! 

7.1 j 


37 


6.8 


19 


! 26 


32 


38 


6.5 


20 


1 27. 


33 


39 


6.2 


21 


! 28 


34 


40 


5.9 


22 


1 29 


35 


45 


3.7 


23 


1 30 


36 


50 


2.0 


24 


i 









19. Angle of convergence. — 
a. Near point of convergence (PcB). 

(1) Apparatus: The Prince rule; a pin with a white head 2 mm. in 
diameter. 

(2) Procedure: The distance to this point is computed from the 
ba*se line connecting the centers of rotation of the eyes. 

The end of the Prince rule is placed at the mark on the right side 
of the nose, 11.5 mm. in front of the cornea. The white-headed pin 
is held 33 cm. away in the median line above the edge of the rule and 
the applicant is instructed to look at it intently. If both eyes are 
seen to converge upon the pin, it is then carried in the median line, 



12 

along- the edge of the rule, toward the root of the nose. The appli- 
m.m's eyes are carefully watched and the instant one is observed to 
swing outward the limit of convergence has been reached. The point 
on the rule opposite the pin is then read in millimeters. This test 
is repeated until a fairly constant reading is obtained. To this 
reading 25 mm. is added, which will give approximately the distance 
from the near point of convergence to the base line. 

(3) Precautions: Both eyes must converge upon the pin at the 
start of the test. The applicant's observation of the onset of diplopia 
is not relied upon to determine the near point. 

(4) Interpretation of findings: The near point of convergence, un- 
like the near point of accommodation, varies little with age. Its 
measurement is of value only in computing the angle of convergence. 
Applicants are not qualiiied or disqualified on this measurement, but 
on the angle of convergence. 

h. Inter pupillary distance (Pd). 

(1) Apparatus: A small millimeter rule. 

(2) Procedure: The examiner stands with his back to the light, 
face to face with the applicant. The rule is held in the examiner's 
right hand and laid across the applicant's nose in line with his pupils 
as close to the two eyes as possible. The examiner closes his right 
eye and instructs the applicant to fix his eyes on the open left eye. 
With the eyes in this position the zero mark on the rule is placed in 
line with the nasal border of the applicant's right pupil. The rule 
must be held steadily in this position while the examiner opens his 
right eye and closes his left. The applicant is then instructed to look 
at the open right eye. The point on the rule in line with the 
temporal border of the applicant's left pupil is read in millimeters 
as the interpupillary distance. 

c. Computing the angle of convergence. — 

(1) Procedure: The following formula is used for computing the 
angle of convergence : 

Angle of convergence^ — — w^ — +3 

(2) Interpretation of findings: An angle of convergence smaller 
than 35° disqualifies the applicant. 

20. Retinal sensitivity. — Until a suitable apparatus for measuring 
retinal sensitivity has been approved, the test is omitted. 

21. Central color vision. — a. Apparatus: The Jennings self-re- 
cording test for color blindness. 

b. Procedure : Central color vision is tested for each eye separately. 
A suitable shield or bandage occludes the eye not being tested. The 
directions on the cover of the Jennings apparatus are strictly fol- 
lowed. 

c. Precautions : The names of colors should not be used in instruct- 
ing the applicant. If lie fails to understand the test, he should name 
the test color himself and be instructed to pick out those which 
appear the same, including lighter and darker shades. The shield or 
bandage is applied without pressure. The color record sheets are 
attached to the 609 form. > 



13 

<(. Interpretation of findings : If it is apparent that mistakes made 
by the applicant are due to color confusion and not to carelessness or 
failure to understand instructions, he is disqualified. 
-22. Field of vision for form and color. — a. Apparatus: A self- 
registering perimeter ; three test objects of standard blue, red, and 
green, each 5 mm. in diameter; a white test object the same size. 

b. Procedure: Each eye is tested separately. A shield or bandage 
occludes the eye not being tested. The field of vision for white and 
for each color is outlined by following the general directions for 
perimetry. The blank on which the perimeter record is made is at- 
tached to the 609 form. 

c. Interpretation of findings : The normal visual field for form is 
largest; those for blue, red, and green are successively smaller in the 
order given. The color fields should be nearly concentric with the 
form field. Any marked contraction of the color fields disqualifies 
the applicant for night flying. Any marked contraction of the form 
field disqualifies the applicant for flying. 

23. Refraction. — a. Apparatus and drugs : Electric retinoscope or 
plain retinoscope and wall lamp; trial case and trial frame; Snellen 
test type; homatropine hydrobromate, 2 per cent solution (homatro- 
pine hydrobromate disks, gr. 1/40 may be substituted). 

&. Procedure : The tension of both eyes must be taken by palpa- 
tion and found normal before instilling a cycloplegic. 

One drop of the homatropine solution is placed in each eye every 
10 minutes and the eyes kept closed. At the end of one hour, the 
range of accommodation of each eye is tested. If it is found reduced 
to one diopter or less, refraction is begun. If not, the drops are con- 
tinued as long as necessary to produce this result. Retinoseopy is 
then done in the dark room and the refraction verified on the Snellen 
charts. The correction and the vision obtained with it are entered 
In the space provided on the blank. 

o. Interpretation of findings: The applicant is disqualified if he has 
in either eye more than one diopter of hyperopia or more than one 
diopter of astigmatism. 

24. Ophthalmoscopic examination. — a. The media, iris, disk, 
blood vessels, and retina of each eye are examined for congenital and 
pathological abnormalities. This examination must not be made be- 
fore the refraction is completed. In examining the macular region 
of the retina, the light should be reduced and the exposure made as 
brief as possible. 

EAR EXAMINATION. 

25- Abnormalities of the ear are causes for rejection. 

26. Hearing should be normal for each ear. To determine this 
both the whisper and watch tests are used. After examining both 
external auditory canals and membrani tympani by means of a 
speculum and a good light (first removing any wax if present) for 
abnormalities such as small and tortuous opening, presence of pus, 
perforation, scars, retraction, or other evidence of past or present 
inflammation, which are causes for rejection, the candidate is 
required to stand at 20 feet from the examiner and facing away from 
him. An assistant closes the ear not under examination with his 
moistened index finger pressed firmly into the external auditory 



14 

meatus. The examiner facing the back of the candidate exhales 
and then, with his residual air, whispers numbers, words, or sen- 
tences which the candidate should repeat. The other ear will then 
be tested in a similar manner. If unable to hear, the examiner will 
approach until the candidate does hear, the distance being recorded 
in feet. If less than 20 feet it is a cause for rejection. A quiet 
room is essential. 

The watch test is preferably made with a loud ticking watch such 
as the ordinary Ingersoll which, while variable, should be heard 
at about 40 inches. Any watch used should have been previously 
tried out on at least five normal persons and the distance heard 
made a matter of record. The number of inches in distance heard 
by the candidate, eyes closed and opposite ear occluded, is taken as 
the numerator and the distance the watch should be heard as the 
denominator. This should be the equivalent of 40/40 ; otherwise dis- 
qualifies. 

NASO-PHAEYNX. 

27. The naso-pharynx region should be carefully examined. If de- 
fects can be removed by operation, this should be required prior to 
completing the examination. If nonoperable or operation refused, 
it *is a cause for rejection. See items under " Naso-Pharynx " on 
Form No. 609, A. G. O. 

EQTJILIBKIUM (VESTIBULAB TESTS). 

28. The nystagmus, past-pointing and falling, after turning, are 
tested. The turning chair must have a head rest which will hold 
the head SO degrees forward, a foot rest, and a stop pedal. 

a. Nystagmus. — Head 30 degrees forward; turn candidate to the 
right, eyes closed, 10 times in exactly 20 seconds. The instant the 
chair is stopped, click the stop-watch; candidate opens his eyes and 
looks straight ahead at some distant point. There should occur a 
horizontal nystagmus to the left of 26 seconds duration. Candidate 
then closes his eyes and is turned to the left; there should occur a 
horizontal nystagmus to the right of 26 seconds duration. The varia- 
tion of 8 seconds is allowable. 

b. Pointing. — (1) Candidate closes eyes, sitting in chair facing 
examiner, touches the examiner's finger held in front of him, raises 
his arm to perpendicular position, lowers the arm, and attempts to 
find the examiner's finger. First the right arm; then the left arm. 
The normal is always able to find the finger. (2) The pointing test 
is again repeated after turning to the right, 10 times in 10 seconds. 
During the last turn the stop pedal is released and as the chair 
comes into position, it becomes locked. The right arm is tested, 
then the left, then the right, then to the left until he ceases to past 
point. The normal will past point to the right 3 times with each arm. 
(3) Repeat pointing test, after turning to the left. 

c. Falling. — Candidate's head is inclined 90° forward. Turn to 
the right, 5 times in 10 seconds. On stopping, candidate raises his 
head and should fall to the right. This tests the vertical semicircular 
canals. Turn to the left, head forward 90° ; on stopping, the candi- 
date raises his head and should fall to the left. Unless each test is 
normal, it is a cause for rejection. 



15 

29. Caloric douche test. — So-called border-line cases can be tested 
by the caloric test, each ear separately. Water at 68° F. is allowed 
to run into the external auditory canal from a height of about 3 
feet through a stop nozzle, with the head tilted 30° forward, until the 
eyes are seen to jerk and the individual becomes dizzy. This should 
be accurately measured by a stop watch. The type of nystagmus is 
then noted. With head in upright position, it should be rotary and 
the direction of the jerk should be to the side opposite the ear 
douched. The length of the douching shown by the stop watch in 
the normal is 40 seconds. The eyes are then closed and the past 
pointing is taken. The head is then immediately inclined backward 
60° from the perpendicular ; there should appear a horizontal nystag- 
mus to the side opposite the ear douched. The eyes are then closed 
and the past pointing is taken with the head in this position. The 
left ear is then douched and the same procedure is carried out. If 
instead of 40 seconds of douching, there was required not more than 
90 seconds, the applicant is not rejected. Care should be taken that 
the cold water reaches the drumhead, as wax or other obstruction in 
the external canal would interfere with the responses in a perfectly 
normal individual. 

GENERAL EXAMINATION. 

30. Special Regulations No. 65, W. D., Nov. S, 1918, and Special 
Regulations No. 50, Aviation Section, Signal Corps, W. D., 1917, will 
govern the general physical examination, except as modified herein. 

31. Minimum height is 60 inches; maximum height, no limit. Mini- 
mum weight is 110 pounds; maximum weight, 180 pounds. Varia- 
tions above or below these limits are allowable if applicant is well 
proportioned and physically sound. 

32. Expansion of chest should be not less than 3 inches in an indi- 
vidual of average size. 

33. Second degree flat foot of even extreme proportions is not dis- 
qualifying in the absence of history or symptoms of incapacitation. 

34. Systolic blood pressure should not exceed 145 mm. The dias- 
tolic should be roughly two-thirds of the systolic. The mere pres- 
ence of a systolic murmur in the absence of history or other cardiac 
symptoms is not disqualifying. 

35. Infected teeth or roots are causes for rejection until corrected 
by proper treatment. 

36. Urine examination : If albumen be found, three successive 
specimens must be clear of albumen before applicant can be accepted. 
The presence of casts or sugar is disqualifying. 

NERVOUS SYSTEM. 

37. Obtain history of insanity and nervous diseases carefully. 

38. Pupils. — Classified as regular or irregular; equal or unequal; 
do or do not react to light and accommodation. Prolonged secondary 
dilatation occurs after the normal slight secondary dilatation and lasts 
5 to 10 seconds. 

39. Station. — Applicant to stand with knees pressed back, arms 
loose by side of body, eyes closed, inner margins of feet touching 
each other. 



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16 

40. Patellar refle.res. — Classified as absent (0) ; diminished ( — ) ; 
normal ( + ); hyperactive (++); exaggerated (+ + +). 

Tic. — Classified as facial, cervical, shoulder. 
Tremor. — Classified as fine and coarse. 
Examine fingers, hands, tongue, eyelids, and lips. 

41. Psj/cho motor tension. — Ability to voluntarily relax. Tested by 
having candidate rest forearm upon palm of examiner and then test- 
ing the tendon reflexes of forearm with percussion hammer. 

Peripheral circulation. — Examine for flushing, mottling, and cya- 
nosis of face, trunk, and extremities. Question as to the presence 
of localized sweating (arm pits and palms) and cold extremities. 

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